Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Ophthalmol. 2023 Mar 1;34(2):95-102. doi: 10.1097/ICU.0000000000000924. Epub 2022 Nov 7.
Advances in surgical techniques and postoperative care have significantly improved rates of short-term complications following keratoplasty; however, glaucoma remains a highly prevalent long-term and potentially devastating complication for postkeratoplasty patients. In this review, we provide an overview of recent literature on glaucoma management in patients who have undergone penetrating keratoplasty or the Boston keratoprosthesis type I (KPro) implantation.
New research suggests an inflammatory cause underlying glaucoma following KPro. Accurate IOP measurement is difficult in patients postkeratoplasty; study of objective techniques such as PDCT or Tono-Pen in penetrating keratoplasty eyes and trans-palpebral Diaton tonometry in KPro eyes have shown promising results. Early glaucoma surgical intervention should be considered for patients undergoing penetrating keratoplasty and KPro.
Patients who have undergone penetrating keratoplasty or implantation of the Boston keratoprosthesis type I should be monitored frequently for elevated intraocular pressure and for other signs of glaucomatous optic nerve damage. Intraocular pressure elevation should be treated promptly either medically or surgically while minimizing risk to the corneal graft. Further research into inflammatory causes and other treatment modalities is promising for the long-term visual success in these patients.
角膜移植术后，外科技术和术后护理的进步显著提高了短期并发症的发生率；然而，青光眼仍然是角膜移植术后患者长期存在且潜在破坏性的高发并发症。在这篇综述中，我们概述了近期关于穿透性角膜移植术或波士顿角膜移植术 I 型（KPro）植入术后患者青光眼管理的文献。
新的研究表明，KPro 术后青光眼的发生与炎症有关。角膜移植术后患者眼压的准确测量较为困难；对 PDCT 或 Tono-Pen 等客观技术在穿透性角膜移植术中的应用以及 Diaton 经皮眼压计在 KPro 眼中的应用进行了研究，结果显示这些技术具有很大的应用前景。对于接受穿透性角膜移植术和 KPro 手术的患者，应考虑早期进行青光眼手术干预。
接受穿透性角膜移植术或波士顿角膜移植术 I 型植入术的患者应密切监测眼压升高和青光眼视神经损伤的其他迹象。应尽快通过药物或手术治疗眼压升高，同时将角膜移植物的风险降到最低。对炎症原因和其他治疗方式的进一步研究，有望为这些患者的长期视力成功提供帮助。
